New NHS guidelines on IVF treatment to extend age limit up to 42 - what do you think?

[JaneGMumsnet]

Good morning,

New IVF guidelines issued by the National Institute of Health & Clinical Excellence (NICE) say that women aged up to 42 should be allowed one cycle of IVF treatment so long as it is their first attempt. Previously Nice recommended treatment up to the age of 39.

The guidelines also suggest that all couples who are struggling to conceive should get fertility treatment more quickly ? after two years of trying to conceive naturally, rather than three.

We'd love to hear what you think.

Thanks,
MNHQ

[PolkadotCircus]

Counselling should be mandatory imvho.

It was amazing for us,not sure I'd have got through it without and it helped us to prepare for moving on in a positive way.

[PolkadotCircus]

Our counselling was free at our private clinic.

[EnjoyResponsibly]

I had counselling too. Very important.

[EnjoyResponsibly]

Jakadaal your last comment is not an unreasonable one. Perhaps as you say better expanded in another thread, but pertinent in this discussion given the time factors we're discussing.

If you find sooner and less stressfully that an IVF solution will not resolve your fertility issues you could consider the move into adoption sooner.

[gaelicsheep]

I haven't had time to read the guidelines in full. What I want to see is an end to the unequal treatment of women in the cruelly labelled "second" relationships.

Where a woman has a partner who, in whatever circumstances, has fathered a child - regardless whether that child is a part of their lives or not, and regardless of the reasons for that - fertility investigations and treatment are frequently denied. Even if the woman has a potential medical problem causing the infertility.

I know not everyone will agree but I have been there and it damned near broke my heart. Thankfully we eventually managed on our own.

[Northey]

As I understand it (from NICE and the BBC), technological advances mean that the success rate now for a 42 year old is the same as the success rate was for the upper age limit (35?) when the guidelines were first drawn up. The (on average) poorer egg quality and lower egg yield is made up for by improved stimming/retrieval/culturing/reinsertion techniques. With that evidence in mind, it's a pretty uncontroversial step, as it matches the original outcome-based criteria for this procedure.

The question of whether or not to fund fertility treatment at all is a different one, and belongs in with all the stuff about whether a soldier with his groin half blown off is more or less deserving of help to create a child than a heavy smoker is deserving of help to overcome lung cancer - ie an interesting and worthwhile discussion, but not fully relevant to today's news, I think.

Incidentally, the BBC and ITV were filming in my clinic yesterday at the very moment I was having an embryo transferred into my uterus. The nurse was most concerned they would accidentally get a shot of me, legs in stirrups!

[FairyJen]

Woul it also be worth considering that there should be more information ad incentive to be donors and surrogates if you are fertile?

I would love to be a surrogate and dp has often talked about sperm donation. His pesky swimmers never miss given I conceived both on the pill ad the implant 99% effective my arse

[sleepyhead]

If it gives a little bit of breathing space to those couples who are sitting on the cut-off and not yet at the top of the waiting list then that's got to be a positive thing.

Obviously fertility does decline (but not at the same rate in every women which makes population statistics just that - a rate for the population, not the individual) but it doesn't just go 39=ok and suddenly the next day you're 40 and post-menopausal.

Any cut-off will be hard on the people that fall just on the other side, but a cut-off of 42 seems to me more in keeping with the number of pregnancies happening naturally in the post-35 age group (ie very, very few happening post-42 compared to few but not all that rare in the 39, 40, 41 age group).

I'm fortunate that we eventually conceived dc2 naturally the month of my 40th birthday, so whatever it was that delayed conception by 3 years obviously wasn't physically insurmountable, but I'm assuming that fertility investigations before IVF will refine the odds of the individual couple conceiving and in many cases a healthy 40 year old may have a better chance than a 35 year old couple with multiple issues.

[gaelicsheep]

That is a very good point about breathing space. The pressure of trying to conceive is bound to affect success rates, so hopefully with the new guidelines that pressure on women aged 38 or 39 will be reduced.

[SteIIaBeIIa]

The UK has no money. Controversial I know but I don't think IVF should be available on the NHS at all. There are so many life threatening and health destroying situations that they don't have funds for.

[EuroShagmore]

nana you are considerably off on your stats. My clinic achieves a live birth rate of 3 times the 5% you quote for 40+: www.createhealth.org/success-rates
And it is by no means the most successful clinic out there.

On average the success rates now are about 1 in 3, and that is per cycle, so most people having 3 cycles will conceive. I think people going through IVF are well-aware of the statistics. In fact, I think the HFEA requires that the clinic gives you a sheet listing various things that you should have had explained to you and there is a space on this form where the dr should fill in what he believes your particular chances of success are. Certainly both the clinics I went to used this form.

miemohrs I came at it from the opposite side of the spectrum to you. I was expecting it to be incredibly difficult. I hate hospitals, I hate drugs and I saw needing IVF as a "failure". I stopped our first cycle half way through because I couldn't deal with it (the physical side effects of the drugs and the mental side). Our relationship didn't suffer (if anything it brought us closer) but we both did as individuals. I had one counselling session at my first clinic but I didn't find it helpful at all. I thought all clinics were required to offer counselling now? I know of one couple who came very close to splitting up post-IVF only to get a miracle natural conception after years of trying. There is no doubt that it takes its toll.

[Theas18]

Going to be a mumsnet pariah for ever now but I'm strongly opposed to these changes.

The NHS is a FINITE budget. There have to be hard choices about where the money is best spent. Treating a 43yr old with IVF is less likely to succeed compared to a 33yr old because of age factors (but also because a non concieving 43yr old has probably been through every other fertility treatment for years and failed to achieve a pregnancy).

My heart goes out to women who have to realise thy will never be a mum but what are we NOT going to use NHS money for to do this? Maybe mumsnet should choose....

Is it cutting budgets for ward cleaning and the basic HCA that actually do the real care tasks in hospital?

Is it not funding expensive cancer treatment for instance herceptin? (I know that's mainstream now but the newer ones that are coming along).

Is it saying right the NHS will only fund the cheapest version of each drug? Don't care if you " can't " swallow tablets - you eat food don't you- no expensive liquid medicine for you (OK that's tongue in cheek but YKWIM).

Go on mumsnet, who's budget would you squeeze this one out of- but don't then moan it YOU are the one sitting in a wet bed because the HCA can't change your sheets till they've done 6 other things, or your granny can't have the cancer treatment they need...

[curryeater]

NanaNina, sorry if my last paragraph came across more flippantly than I meant it, I know these things are done very very carefully and consideredly. What I meant was: in the midst of my musings about how infertile couples could perhaps have their pain eased by adoption, I should also also acknowledge that for that to happen, someone (unless dead) will have to lose their child; and that is not an easy decision to make.

A lot of people on this thread seem to think that stressing medical causes of infertility justifies publically funded treatment. I don't know why that should be the case; I don't know why an arbitrary demarcation of medical = worthy, and by implication, societal causes of childlessness as less so. (I suppose it might be some sort of subconscious conflation of invalid = victim = blameless or something)

If I did not have children it would arguably be because of mental health issues, arguably because of disorganisation. I did not arrange my life towards having children (until it was nearly too late) - good stable relationship, good income, good home - because I was depressed and was not able to, and also didn't think I was worth it. If I did not have children, I would be very sad. Arguably my problems could have been solved sooner by counselling (actually what happened was a very forthright friend took me in hand, but other than her no one seemed to give a shit about the fact that I was a blatant mess in a thousand ways). Treatment was not forthcoming. Why would such a person be less deserving than someone with a blocked tube?

Similarly, if a woman who is having difficulty conceiving is told that it may be because she is overweight, it is very unlikely that she will receive any effective help to remedy this. Why is she less important than the blocked tube person?

If a person is desperate to have children but doesn't attempt to conceive because she feels that her income / housing situation is too unstable, there is no help for her either. This is a huge problem for young people. If you could have children without worrying about where they were going to live or how you could support them, maybe people wouldn't be panicking in their late 30s or 40s.

[ArielThePiraticalMermaid]

Thea, this has been discussed in the thread. Perhaps you could read it and see what people's thoughts on this already have been.

[Northey]

theas, a non-conceiving 33 year old will also very likely have run through all the other infertility treatments for years. They do kind of leave ivf till last...

[RedToothBrush]

The NHS is SUPPOSED to give universal treatment and care.

IT DOES NOT

Whilst I welcome this, I can't help but feel this will cause even more heartbreak as women think they will now be able to have IVF on the NHS only to find out the reality that NICE is only a guideline and politics dictates whether they can actually have it, rather than the best recommended practice.

In my PCT there is NO IVF. Not for anyone. Well if you can afford it of course... So if you were 41 or 42 this makes fuck all difference.

We need to put even more pressure on the politicians Trust Management to actually follow what NICE say so that care is universal.

[sleepyhead]

Theas18 - where are you getting 43 from? The cut off proposed is 42.

To calculate the cost implications you'd need to know how many extra cycles of IVF would actually arise from this guidance. Firstly, it's just guidance and it could well be that PCTs (or their replacement) decide that no, they won't fund IVF for this age group, as would be their entitlement.

There are many things the NHS funds that people would question the value of. It tends to be something that is heavily influenced by your personal perspective - eg in the case of expensive cancer drugs many of us would question the value of a drug that gives on average an extra two weeks of life expectancy. If it's your life, or your loved one, then you have a different view on that.

[ArielThePiraticalMermaid]

Go on mumsnet, who's budget would you squeeze this one out of- but don't then moan it YOU are the one sitting in a wet bed because the HCA can't change your sheets till they've done 6 other things, or your granny can't have the cancer treatment they need...


So if I have IVF on the NHS at 40, and my granny is left in wet sheets, it is somehow my fault? .

I see what you're saying here, but would you say the same to the person who has overeaten all their life and has heart disease/cancer/stroke, or the smoker who needs lung cancer treatment, or the drunk guy who gets glassed, or the drink driver who needs scraping off the road? Because that's where your logic goes.

[Theas18]

Sorry 42 not 43 but the broad argument is the same

[sleepyhead]

I doubt you'll be able to employ many elderly care nurses for the cost of these (hypothetical) extra rounds of IVF tbh.

The elderly care budget is around 80% of NHS spending and arguably needs to be higher. What else do you propose we cut, because cutting fertility treatment will be a drop in the ocean.

[RedToothBrush]

Theas, my feeling about rationing of care is this:

Why do NICE recommend treatments? They do so in part because the alternatives are very often MORE expensive or have a detrimental effect on the person concerned, which have a knock on effect on their health.

So why are they recommending that treatment be available? Think about it and think about it HARD.

You CAN NOT ration healthcare to anyone without there being an effect. It is impossible. This goes for IVF as much as the granny with cancer. Its just that one is deemed more politically acceptable than the other; not that the need is necessarily less.

And I do believe there is enough money in the NHS. I just think the NHS is a speculator example of how to waste money by pissing it up the wall and just generally is abused by members of the public and staff.

[5madthings]

Is counselling not mandarory?! I donated eggs last year and it was mandatory fir that. It was an invasive process but my egg recipient had twins!! I dont see tge point of pitting funding for ivf etc against cancer treatment. They are both important.

I was lucky enough to concieve easily and i am veru grateful for that blessing and so i donated eggs to give someone else a chance to have a child. I have seen the heartache of fertility problems and ivf via friends and wanted to do something to help. Ultimately its just luck if you have babies easily, i got lucky and wanted to share that luck. I woukd never begrudge the nhs paying for fertility treatment, just pleased we have the ability to help through science and wish it was more available.

Goid luck to any ladies ttc and going through fertility issues xxx

[maamalady]

I'm not convinced by the higher age - success rates of IVF fall with age, and as has been said, IVF is not a guaranteed cure for infertility.

However, making an attempt to get couples through the doors earlier would be hugely beneficial. DH and I are both just 30 and have been TTC for three years - we've just had our IVF referral and will be going to our first appointment in March. It is a hellishly long time to wait - and from about 18 months in neither of us had much hope that anything would happen without medical intervention. We suffer from "unexplained infertility", so there's nothing theoretically wrong with either of us, but yet we are not parents.

If this prolonged stress and severe emotional/mental distress could be reduced for anyone going through this, I welcome it. If nothing else, the chance to try IVF brings closure. DH and I are lucky enough that the postcode lottery allows us three cycles on the NHS, and we have been saving such that we may potentially be able to do another three privately. After that, the line is drawn and we can think about adoption knowing we've tried our best.

Stringing the referral process out not only makes IVF less likely to work (by performing it on an older woman), but also prolongs the deeply distressing situation of TTC while infertile.

[SteIIaBeIIa]

This is another of these "entitlement" issues isn't it? Women feel they are "entitled" to be mothers. Well we're not. Some of us do and some of us don't.

It's not something that taxpayers should be contributing towards IMO - especially in these times when there is NO MONEY.